HIV infection, tuberculosis, and hazardous drinking are of increasing concern in Russia. While the number of officially registered cases of HIV infection as of October 31, 2000 was 69,120, experts expect an exponential increase in the number of Russian people infected with the human immunodeficiency virus in the next 10 years. Incident cases of TB and multi drug resistant tuberculosis in Russia are among the highest in the world. Mortality rates exceed 10% with over 125,000 persons receiving medical treatment for active TB in 1999. Hazardous drinking is common and a major source of morbidity and mortality in Russia. Alcohol use also complicates prevention and treatment programs for HIV infection and TB. Russia shares borders with 13 countries. The global health implications of a large reservoir of HIV infection and tuberculosis in a country that crosses 8 time zones is enormous. Now is the time to prevent the spread of HIV infection and tuberculosis in Russia and neighboring countries. Potential strategies include testing of HIV prevention programs (i.e., Project RESPECT) and treatment programs to reduce rates of hazardous drinking. This proposal is designed to increase our understanding of HIV risk factors, and to increase the role and treatment of alcohol use disorders in the prevention of HIV infection in the context of a TB treatment population. This proposal will conduct the following 3 studies in St. Petersburg and Ivanovo, Russia: a) a prevalence study designed to assess the frequency of HIV risk factors and alcohol use in a patient population being treated for tuberculosis (n=600); b) a naturalistic study designed to assess the effects of alcohol use on HIV risk behaviors and TB treatment outcomes (n=200); c) a combined day-treatment program for HIV risk reduction and alcohol treatment (n=80). The data from these studies will provide new information. The findings are expected to facilitate the development, testing and implementation of HIV prevention and alcohol treatment programs. It is hoped that these programs can reduce the spread of HIV infection and TB in Russia and neighboring countries.